Provider Demographics
NPI:1881694982
Name:PHILLIPS, RAY ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:ANTHONY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N CHAUNCEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1735
Mailing Address - Country:US
Mailing Address - Phone:260-244-6012
Mailing Address - Fax:260-244-6012
Practice Address - Street 1:330 N CHAUNCEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1735
Practice Address - Country:US
Practice Address - Phone:260-244-6012
Practice Address - Fax:260-244-6012
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000335479OtherBCBS / ANTHEM
IN930790Medicare ID - Type Unspecified
T35144Medicare UPIN